Development and initial evaluation of a novel simulation model for comprehensive brain tumor surgery training

Abstract

Background Increasing technico-manual complexity of procedures and time constraints necessitates effective neurosurgical training. For this purpose, both screen-and model-based simulations are under investigation. Approaches including 3D printed brains, gelatin composite models, and virtual environments have already been published. However, quality of brain surgery simulation is limited due to discrepancies in visual and haptic experience. Similarly, virtual training scenarios are still lacking sufficient real-world resemblance. In this study, we introduce a novel simulator for realistic neurosurgical training that combines real brain tissue with 3D printing and augmented reality. Methods Based on a human CT scan, a skull base and skullcap were 3D printed and equipped with an artificial dura mater. The cerebral hemispheres of a calf's brain were placed in the convexity of the skullcap and tumor masses composed of aspic, water, and fluorescein were injected in the brain. The skullcap and skull base were placed on each other, glued together, and filled up with an aspic water solution for brain fixation. Then, four surgical scenarios were performed in the operating room as follows: (1) simple tumor resection, (2) complex tumor resection, (3) navigated biopsy via burr hole trepanation, and (4) retrosigmoidal craniotomy. Neuronavigation, augmented reality, fluorescence, and ocular-as well as screen-based (exoscopic)-surgery were available for the simulator training. A total of 29 participants performed at least one training scenario of the simulator and completed a 5-item Likert-like questionnaire as well as qualitative interviews. The questionnaire assessed the realism of the tumor model, skull, and brain tissue as well as the capability for training purposes. Results Visual and sensory realism of the skull and brain tissue were rated,"very good," while the sensory and visual realism of the tumor model were rated "good." Both overall satisfaction with the model and eligibility of the microscope and neurosurgical instruments for training purposes were rated with "very good." However, small size of the calf's brain, its limited shelf life, and the inability to simulate bleedings due to the lack of perfusion were significant drawbacks. Conclusion The combination of 3D printing and real brain tissue provided surgical scenarios with very good real-life resemblance. This novel neurosurgical model features a versatile setup for surgical skill training and allows for efficient training of technological support like image and fluorescence guidance, exoscopic surgery, and robotic technology.

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

“…Also, learning new surgical skills is different from perfecting them, which implies that they have to be repeated with constancy over time ( 15 ). The neurosurgical learning curve is still too long and dominated by conventional mentor–apprentice relationships ( 16 ).…”

“…In this scenario, neurosurgical simulators are becoming increasingly important. Among the modern surgical training solutions, interest in VR or AR and 3D models has been growing ( 16 , 17 ). Our experience with hybrid AR and 3D-printed neurosurgical simulator showed that the combination of such learning methods could lead to interesting results.…”

Letter to the Editor: How is COVID-19 Going to Affect Education in Neurosurgery? A Step Toward a New Era of Educational Training

“…Neurosurgical residents have the possibility to exercise on different common surgical procedures with no clinical risks. 10 This technology can boost the surgeon's confidence and reduce the steepness of her or his learning curve, especially with technically demanding procedures. 10 These simulations are not resident-dependent; in fact, they need to be supervised by experts who should be able to evaluate the performance of residents and suggest to them how to improve their skills.…”

“…10 This technology can boost the surgeon's confidence and reduce the steepness of her or his learning curve, especially with technically demanding procedures. 10 These simulations are not resident-dependent; in fact, they need to be supervised by experts who should be able to evaluate the performance of residents and suggest to them how to improve their skills. Residents' performance should be also recorded, not only for the supervisors' evaluation, but also to be able to track signs of progress over time.…”

Obstacles to cadaver use for the development of neurosurgical techniques and devices in Japan

“…In particular, disease-specific models such as those with cerebral aneurysms and brain tumours are becoming more accurate and are promising methods for preoperative simulation from a realistic perspective [1,10,11,22]. However, due to the difficult construction of materials, some prototypes lacked brain tissue, and some used animal brain tissue [4,23]. The 3D model has not been sufficiently verified for its usefulness in comparison with the educational tools such as two-dimensional models developed for residents.…”